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yf, Baked Goods <br />E Candy <br />E Churros <br />Buttercream <br />Frosting/Icing* <br />E] Dried Mole Paste <br />E Dried Pasta <br />El Dry Baking Mixes <br />El Waffle Cones <br />El Buttercream <br />Fondant/Gumpaste" <br />D Herb/Spice Blends <br />SAN JOAQUIN <br /> <br />Environmental Health Department <br />—COUNTY <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />CFO Business Name: Owner Name: <br />T1 'S T—rf CITS An <br />CFO Physical Address. CFO City: <br />570 ri 1-5c r-eek Place, Mfec ci <br />Website (If applicable): Telephone: <br />(2_cci)cfg -855 I <br />Dat <br />CFO Zip: <br /> <br />Categories: <br />"Class A" (Direct Sales Only) $186 E "Class B" (Direct & Indirect Sales) $312 <br />Prohibited Items: Initial if you agree to abide by the following: <br />Foods containing cream, custard, or meat fillings are potentially hazardous and are NOT ALLOWED. Only foods <br />that are defined as "non-potentially hazardous" are approved for preparation by a Cottage Food Operation. These <br />foods include items that do not require refrigeration to keep them safe from bacterial growth that could be a cause of <br />food-borne illness. <br />"Class A" Self Certification Checklist: <br />E Checklist completed ("Class A" CFOs Only) <br />Products: <br />Please check the items you will be preparing and/or selling. <br />El Fruit Empanadas E Fruit Tamales/Pies <br />E Granola/Cereals El Seasoning Salt <br />Ill Cotton Candy E Candied Apples <br />CI <br />El <br />El <br />CI <br />El <br />Honey <br />Mustard <br />Dried Grain Mixes <br />Flat Icing <br />Pizzeles <br />Nut Mixes/Nut <br />Butters <br />Trail Mix/ Dried Fruit <br />Salted <br />Caramel/Fudge <br />El <br />LI <br />111 <br />CI <br />E] <br />E <br />E <br />El <br />Popcorn/ <br />Popcorn Balls <br />Vinegar <br />Fruit Butter** <br />Ground <br />Chocolate <br />Jams/Jellies — <br />Fried or Baked <br />Donuts and <br />Waffles <br />Dried Fruit <br />Marshmallows/ <br />Marshmallow <br />Bars" <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sjgov.org/ehd <br />k9k91-6341